Maintenance of Certification
Essentials
SCAMPs to the rescue????
Credentialing Organizations


Self appointed, generally non-profit
organizations that rely on monopoly or external
acceptance for validity
ABMS Purpose (1908): To define specialty
qualifications, to supervise examinations that
test the preparation of those who desire to
practice and to issue credentials that would
assure the public of the specialist's qualifications
American Board of Medical
Subspecialties












Allergy and immunology
Anesthesiology
Colon and rectal surgery
Dermatology
Emergency medicine
Family medicine
Internal medicine
Medical genetics
Neurosurgery
Nuclear medicine
OB/GYN
Ophthalmology












Orthopedic surgery
Otolaryngology
Pathology
Pediatrics
Physical med & rehab
Plastic surgery
Preventive medicine
Psychiatry and neurology
Radiology
Surgery
Thoracic surgery
Urology
Permanent Certificates
On November 30, 2009, James A.
Stockman, III, M.D., president of the
American Board of Pediatrics admitted
under oath at a North Carolina Medical
Board hearing that 41% of ABMS boarded
physicians are board certified for life, i.e.
are not required to be re-certified every
several years like its competitors (AOA and
ABPS) require
American Board of Physician
Specialists








Anesthesiology
Dermatology
Diagnostic Radiology
Disaster Medicine
Emergency Medicine
Family Medicine & Ob
Family Practice
Geriatric Medicine








Hospital Medicine
Internal Medicine
Obstetrics and GYN
Ophthalmology
Orthopedic Surgery
Psychiatry
Radiation Oncology
Surgery
American Osteopathic Association
Bureau of Osteopathic Specialists









Anesthesiology
Dermatology
Emergency Medicine
Family Physicians
Internal Medicine
Neurology and Psychiatry
Neuromusculoskeletal
medicine
Nuclear medicine
Obstetrics and
Gynecology









Ophthalmology and
Otolaryngology
Orthopedic Surgery
Pathology
Pediatrics
Physical Medicine and
Rehabilitation
Preventive Medicine
Proctology
Radiology
Surgery
The “MOC” Rationale



Response to the quality-of-care movement and
related concerns of the public
Federation of State Medical Board is developing
a process whereby demonstration of ongoing
competence is a requirement for licensure
renewal (maintenance of licensure)
MOC qualifies for MOL requirements, even for
non-board certified physicians
Understanding Maintenance of
Certification
Presented By:
The American Board of Pediatrics
About the ABP
Sole mission is to the public.
Independent certifying board;
Those certified are known as
diplomates of the Board.
One of the 24 specialty boards of
the American Board of Medical
Specialties (ABMS)
The American Board of Pediatrics
111 Silver Cedar Court
Chapel Hill, NC 27514
Created in 1933 by the pediatric
community to certify physicians
with specialized education and
clinical expertise in the care of
children
Includes 250 physicians who
volunteer their time to set the
standards of certification
The Evolution of Board Certification
Permanent Certification
Until 1988, certification was done by successfully passing a test of
knowledge only once in a career, typically at the end of training.
Time-Limited Certification
Beginning in 1989, a diplomate was required to successfully pass a
similar test of knowledge every 7 years.
Maintenance of Certification (MOC)
Beginning in 2010, diplomates will maintain certification by continual
evaluation of the competencies verified during residency. A secure
test of knowledge is one part of this four-part program.
The ABP certifies
physicians who
demonstrate a
commitment to lifelong
learning and providing the
highest quality care.
Certification is a
self-regulated, professional
responsibility.
ACGME Accredited Residency
Training
ABP Initial Certification
Examination
ABP Maintenance of
Certification
What is Maintenance of Certification?
(MOC)
•4-part program that you begin once you
have passed your initial certification
examination.
•Evaluates the same 6 ACGME core
competencies measured throughout
training.
•Competencies are assessed in
5-year cycles, as defined by Maintenance
of Certification.
The Purpose of MOC
For The Public:
MOC has been developed to assure the public that diplomates certified by the American Board
of Pediatrics have demonstrated:
•Professionalism
•Commitment to lifelong learning
•Specialized knowledge of Pediatrics
• Dedication to continuously improving care
For The Pediatrician:
Participation in MOC:
•Leads to better care for children
•May help you meet payer, regulatory and consumer demands for quality
•Represents to the public your commitment to providing quality care
•Acknowledges your achievement of the gold standard in pediatric care
Measuring the 6 Core Competencies
Part 1 – Professional Standing
Patient care, Interpersonal & communication
skills, Professionalism
Part 2 – Knowledge Assessment
Patient care, Medical knowledge,
Practice-based learning &
improvement, Systems-based practice
Part 3 – Cognitive Expertise
Medical knowledge
Part 4 – Performance In Practice
Patient care, Practice-based learning
& improvement, Interpersonal
& communication skills, Professionalism,
Systems-based practice
Part 1 MOC - Professionalism
Requirement for Part 1 :
All diplomates must hold a valid, unrestricted
medical license.
Part 2 MOC – Knowledge Self Assessment
40-point minimum per 5-year MOC cycle
Requirements for Part 2 :
All approved Part 2 activities are
assigned a point value by the ABP.
Diplomates must complete
activities provided by either the
ABP or approved outside
providers.
You must have at least 40 points
of Part 2 activities per 5-year MOC
cycle.
Web Based Modules
MOC Points
Adolescent Medicine
15
Allergy and Immunology
20
Child Abuse
15
Critical Care Medicine
15
Development and Behavior
15
General Pediatric Decision Skills
20
General Pediatric Knowledge
10
Neonatology
15
Pediatric Cardiology
15
Pediatric Emergency Medicine
15
Pediatric Nephrology
15
Pediatric Sports Medicine
15
PREP Self-Assessment*
20
Principles of Quality Improvement
20
*Developed and administered by the AAP; requires payment directly to the
AAP for access
Part 3 MOC – Cognitive Expertise
Requirement for Part 3 :
Although the MOC cycle is 5 years, a secure
test of knowledge is only required
every 10 years.
Successfully pass a secure test of knowledge
every 10 years in each area of certification.
1969
1980-1991
ABMS introduces
Recertification
Closed Book
(voluntary)
1993-2002
1993
- 2002
Open Book Exam
(every 7 years)
2003-present
2010+
Secure Exam
(every 7 years)
Secure Exam
(every 10 years)
NOTE!
Because examinations are only
required every 10 years, it’s
important to note that the
exam does not necessarily
coincide with the
beginning or end of your
5-year MOC cycle.
Part 4 MOC – Performance in Practice
40-point minimum per 5-year MOC cycle
Requirements for Part 4 :
Option 1: The Part 4 MOC requirement for Performance In Practice can be
met by completing web-based Quality Improvement activities.
Option 2: Participate in an ongoing ABP-approved collaborative Quality
Improvement project.
Part 4 MOC – Menu of Options
Web Based Modules
2 options for
completion
Point values not yet finalized
by the ABP.
MOC Points
EQIPP Modules from AAP* (asthma, ADHD, nutrition, immun,
development)
25
Performance Improvement Modules (PIMs) from ABP
20
ABMS Patient Safety Module
25
ABP Approved QI Projects**
MOC Points
Vermont Oxford Network (3 projects)
25
California Perinatal Quality Care Collaborative
25
NACHRI Blood Stream Infection Project
25
Iowa BCBS Asthma and Immunization
25
UPIQ (state wide obesity project in Utah)
25
Cystic Fibrosis Foundation
25
CHCA (3 projects on hospital codes and throughput)
25
Part 4 MOC – Performance In Practice
Examples of Option 1
(Web-based QI Project)
AAP Web-based Modules
Patient Safety
Improvement Program
ABP Performance Improvement
Module for ADHD
Part 4 MOC – Performance In Practice
Example of Option 2
(Collaborative QI Project)
29 children’s hospital PICUs
are collaborating to reduce
catheter-related
bloodstream infections. This
project has been approved
by the ABP for Part 4 credit
and points.
Part 4 MOC – Performance In Practice
Another Example of Option 2
(Collaborative QI Project)
100%
Long Term Goal
= 95%
90%
80%
70%
60%
Results:
50%
44%
22%
30%
40%
hospital admissions
urgent care/ED visits
missed school days
30%
20%
10%
Medicaid/Uninsured
Oct 05
Sep 05
Jul 05
Aug 05
Jun 05
May 05
Apr 05
Mar 05
Feb 05
Jan 05
Dec 04
Oct 04
Commercially Insured
Nov 04
Sep 04
Aug 04
Jul 04
Jun 04
May 04
Apr 04
Mar 04
Jan 04
Feb 04
Dec 03
Nov 03
0%
Oct 03
160 practicing pediatricians
decided to work together to
improve care for their children
with asthma. They set an
ambitious goal – that all 44
participating practices would
achieve “perfect care.” Together,
the physicians created the
infrastructure necessary to
measure improvement, created
data collection and patient
tracking procedures and trained
coaches to help. Within 2 years,
the network moved from a 4
percent compliance rate in
applying “perfect care” to an 88
percent rate.
Perfect Care for Asthma (Cumulative %)
Parts 2 and 4 – How It All Adds Up!
A total of 100 points is required per 5-year MOC cycle.
40 points – Part 2 activities
+
40 points – Part 4 activities
+
20 points – Your choice (Part 2 or 4 activities)
100 required points per 5-year MOC cycle
Enrollment, Fees and Tracking
If you do not currently have one, simply register
online for your personal physician portfolio.
When you begin your MOC cycle, your portfolio
will contain:
A list of your completed requirements
A list of outstanding requirements in your
current MOC cycle
The timeframe in which you must complete
your next required MOC examination.
MOC At-A-Glance
Part 1: Valid, unrestricted license
Need
100
points
total
Part 2: Earn at least 40 points from approved
activities*
Part 3: Pass a secure exam every 10 years
Part 4: Earn at least 40 points from approved
activities*
*Choose activities from either Part 2 or 4 to earn the
additional 20 points you need to fulfill your 100 point
requirement.
Questions?
Visit the ABP website at www.abp.org
Contact the ABP:
Initial Certification: gpcert@abpeds.org
Subspecialty Certification: sscert@abpeds.org
Maintenance of Certification: moc@abpeds.org
By phone: (919) 929-0461
Physician QI and MOC

“Meaningful participation”





Deliver direct patient care as part of QI project
Implement the changes designed to improve care
Collect, submit and review data for QI activity
Collaborate actively (at least 4 project meetings)
Length of participation


Variable, but generally about 1 year
Completion date must be within MOC cycle
ABP QI Project Requirements








Impact one or more IOM dimensions (safety,
effectiveness, timeliness, equity, efficiency, and patientcenteredness)
One or more well-defined project aims
Use of standard QI methods
Training on QI methods
Adequate project structure (sponsor, leadership,
infrastructure)
History and results of the project
Documentation (design, process, policies, results)
HIPAA compliance
Structure

Project must have:




Sponsoring organization: identified permanent
entity that is responsible and accountable
Institutional governance approval
Documented organizational structure
Designated physician project leader
Options


Organizations running QI projects can apply to
the ABP to gain approval as a MOC activity
Organizations can apply to the ABP to be a
Portfolio Sponsor Organization



Sponsor applies to ABP ($10,000 - $30,000!)
If approved, the sponsor manages its own QI projects
including deciding which qualify for MOC
Management includes tracking physician participation
and granting MOC points
Proposal



Boston Children’s Hospital to act as
Portfolio Sponsor Organization
Each SCAMP would be designed to qualify
as MOC-eligible QI activity
Physician participation for at least one
year in 2 different SCAMPS would meet
MOC requirements for the 5 year MOCcycle
Advice



Part 2 activity can be done over the course of
the 5 year cycle. Attempting to achieve all 40
points the night before due date is unlikely to
succeed
Part 4 activity requires at least one year of
participation prior to due date – plan ahead
The ABP website maintains a page for each
diplomate with requirements, due dates, etc.
Aurora Borealis – April 2009